A systematic review and meta-analysis of the attachments used in implant-supported overdentures

Abstract

Aim: To evaluate the survival rate, tissue response, and patient satisfaction of different attachments used in implant overdenture. Settings and Design: Systematic Review and Meta-analysis. Materials and Methods: Electronic search of peer-review articles published between 2001 and 2019 assessing the attachments used for implant-supported overdentures was done according to PRISMA Guidelies. The review evaluated sixteen articles related to survival of the attachments, the reaction of the soft and hard tissues along with repair and maintenance of the attachments, and overall performance of the overdenture attachments. Statistical Analysis Used: There is statistically significant heterogeneity (Q =374.7403, df = 15, and P < 0.0001). The statistics of fixed-effect model reported an MD of − 0.0880 (95% CI = −0.1536; 0.0225). Result: The review evaluated the 16 articles that met with the inclusion and search criteria. The studies were the combination of bar and ball attachments and their subtypes, magnetic and bar attachments, and locator in combination with other attachments. The meta-analysis of combined 16 studies reported acceptable heterogeneity among 16 studies (I 2 = 96%) and reported to be statistically significant ( P < 0.01). Conclusion: The survival rate of attachments was in the range of 95.8%–97.5% for bar, 96.2%–100% for ball, 90%–92% for magnet and locator attachments were in the range of 97% after a mean follow-up period of 3 years. The bar attachments reported moderate tissue reaction in the form of mucosal changes, gingival inflammation, and bone resorption. The locator attachments require higher maintenance and repair. The magnetic attachments produce higher bone resorption and readily displace under functional force. Patient satisfaction and compliance was higher for ball, locator, and bar attachments as well as low for magnetic attachment. Thus, the ball and locator attachments excellently perform in terms of survival rate, tissue response, and patient satisfaction.

Biomechanical Aspects of Various Attachments for Implant Overdentures: A Review

“…One study reported 34 prosthetic complications and a locator housing requiring 16 replacements [ 8 , 15 ]. To avoid complications, locator attachments require periodic repair and higher maintenance [ 24 ]. Recently, researchers invented a double-crown attachment option for locator attachments have that connects dentures to prepared teeth [ 25 ].…”

“…Overdenture attachments present very high survival rates. One study reported survival rates ranging from 96% to 97% for bar attachments, 96% to 100% for ball attachments, 90% to 92% for magnets, and 97% for locators with a mean follow-up period of 3 years [ 24 ]. Other studies have reported a 94% five-year survival rate for the bar attachment [ 28 ]; 89% and 93% survival rates for the bar and locator, respectively; [ 29 ], and 98% and 97% survival rates for the bar and the locator, respectively [ 30 ].…”

“…Various prosthetic factors and attachments have impacts on peri-implant health [ 24 , 42 ]. Aldhohrah et al [ 2 ] reviewed the effect of the current attachment systems used in two-implant-retained mandibular overdenture (including bar, ball, locator, resilient telescopic, and magnet attachments) on peri-implant tissue health; they reported that all attachment systems had the same effect on marginal bone loss and probing depth.…”

“…Aldhohrah et al [ 2 ] reviewed the effect of the current attachment systems used in two-implant-retained mandibular overdenture (including bar, ball, locator, resilient telescopic, and magnet attachments) on peri-implant tissue health; they reported that all attachment systems had the same effect on marginal bone loss and probing depth. Moreover, Chaware and Thakkar [ 24 ] reported that maintaining peri-implant tissue health is more difficult for the bar attachment, which showed moderate gingival inflammation and bone resorption, than other attachments.…”

Fundamentals of Implant Overdenture-Overview

“…The clinician on average, spent about 15 minutes more adjusting conventional dentures [18]. The patient should not be encouraged to accept a fixed prosthesis if a removable prosthesis can predictably satisfy a patient's needs and desires [21].…”